Abstract: TH-PO0520
Safety of Regional Citrate Anticoagulation for CRRT in Patients with Liver Disease: A Single-Center Cohort Study
Session Information
- Dialysis: Novel Therapeutics and Medication Management
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Abas, Dani, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Chennou, Fella, University of Toronto, Toronto, Ontario, Canada
- Cote, Jean Maxime, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
Background
Regional citrate anticoagulation (RCA) is recommended in CRRT. It was shown to prolong circuit lifespan and reduce bleeding. Severe hepatic disease raises concerns for citrate accumulation. RCA was previously contraindicated in liver disease, but recent data suggest it's feasible. We developed a flexible low-citrate concentration protocol (Regiocit, Vantive) for patients with liver disease.
Methods
We conducted a single-center retrospective study (Jan 2021–Dec 2023) in critically ill patients who received CVVHDF for at least 24 hours. Primary outcome was circuit lifespan by anticoagulation type (Heparin/no anticoagulation vs. RCA) and liver disease status.
Secondary outcome was RCA safety assessed by total-to-ionized calcium ratio. Calcium ratio was calculated using minimum ionized and maximum total calcium from the final 24 hours of each circuit. Active liver disease was defined as cirrhosis, ALT >5x the upper limit of normal (ULN), or total bilirubin >3× the ULN.
Results
A total of 252 patients were included (median age 61 years; 68% men), contributing 1087 CVVHDF circuits. Of these, 416 circuits (38%) were used in patients with active liver disease; 98 (24%) received RCA and 318 (76%) received heparin/no anticoagulation. Filtration fraction was similar between anticoagulation groups regardless of liver disease status. Blood flow rate was higher with heparin/no anticoagulation compared to RCA. After excluding circuits that were stopped for an exam or procedure, lifespan was similar between patients with and without liver disease regardless of anticoagulation. In the citrate group, the mean lifespan in hours was 34.9 (±23) in liver disease patients vs. 47.7 (±24) in the comparison group (p=0.794). In the heparin/no anticoagulation group, it was 33.2 (±22) vs. 36.8 (±23) hours, respectively (p=0.203). For RCA, the calcium ratio was similar with or without liver disease (2.16 vs. 2.11; p=0.148). Eleven circuits had a ratio >2.5, with five from one patient. No severe citrate accumulation requiring CRRT cessation occurred.
Conclusion
Patients with liver disease had adequate circuit lifespan and no increased occurrence of citrate accumulation with RCA. Proper monitoring and a flexible protocol allow RCA to be a safe and feasible anticoagulation choice in patients with hepatic dysfunction.